MedicaidPrior AuthMedium impact
Susvimo® (ranibizumab) (Revised)
Humana·OH · Ophthalmology·Medicaid
Effective date
Aug 1, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicaid Ohio has updated prior authorization requirements for Susvimo (ranibizumab) intravitreal injections used to treat eye conditions including wet AMD, diabetic macular edema, and diabetic retinopathy. The policy requires patients to have contraindications to bevacizumab or failed prior bevacizumab therapy, plus at least 2 prior VEGF inhibitor injections before approval.
Action Required
By August 1, 2025: Billing team must update prior authorization protocols for Susvimo (ranibizumab) injections for Humana Medicaid Ohio patients. Ensure documentation includes diagnosis of wet AMD, diabetic macular edema, or diabetic retinopathy; contraindication/intolerance to bevacizumab OR failed bevacizumab therapy; and history of at least 2 prior VEGF inhibitor injections. Update encounter forms to remind providers of these requirements. Claims without proper prior authorization will be denied.